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The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations.
The book covers a range of topics, including compliance with the UR Conditions of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members.
This book will help you do the following:
- Identify the components of a best practice hospital utilization review (UR) program
- Describe the legal obligations of the hospital to comply with Chapter 42 CFR 482.30 of the Conditions of Participation (CoP)
- Use the publication as a tool to assess his or her own hospital's UR processes
- Summarize the benefits of a dedicated UR team to promote compliance with the CoP
- Facilitate the development of a contemporary UR committee
- Assess an organization's opportunities to improve processes to benefit patient care and hospital success
- Recommend compliant language for the organization's UR plan
- Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources
- Seek out operational resources to perform high-quality reviews that fully comply with the CoP - Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives
Table of Contents
Chapter 1: History of Utilization Review
Chapter 2: The Regulatory Environment
Chapter 3: The Utilization Review Committee
Chapter 4: The Utilization Review Team and Its Partners
Chapter 5: The Utilization Review Process
Chapter 6: Tools, Training, and Resources for the Utilization Review Team
Chapter 7: Progression of Care
Chapter 8: Legal and Ethical Considerations
Who should read this book?
- Case managers
- UR coordinators
- UR committee members
- UR physician advisors
- Nurse managers
- Revenue cycle managers
- Compliance officers and auditors
- Healthcare lawyers and consultants
- Sales Rank: #989597 in Books
- Published on: 2015-04-16
- Original language: English
- Number of items: 1
- Dimensions: .0" h x .0" w x .0" l, .0 pounds
- Binding: Perfect Paperback
- 158 pages
About the Author
Stefani Daniels, RN, MSNA, ACM, CMAC, is founder and managing partner of Phoenix Medical Management in Pompano Beach, Florida. She is a member of the editorial boards of HCPro's Case Management Monthly, Lippincott's Professional Case Management journal, and the Case Management Society of America's (CMSA) Today. She is the coauthor of the popular text The Leader's Guide to Hospital Case Management and a contributing author to CMSA's Core Curriculum for Case Managers, Second Edition. Daniels' articles appear in many healthcare journals and magazines, and she is a popular speaker on contemporary care management at regional and national venues.
Ronald L. Hirsch, MD, FACP, CHCQM, is vice president at AccretivePAS® Clinical Solutions in Chicago. He is a general internist and HIV specialist. Dr. Hirsch was the medical director of case management at Sherman Hospital in Elgin, Illinois. He is certified in healthcare quality and management by the American Board of Quality Assurance and Utilization Review Physicians. In addition, he is a member of the American Case Management Association, a member of the American College of Physician Advisors, and a fellow of the American College of Physicians.
Most helpful customer reviews
2 of 2 people found the following review helpful.
A thorough and comprehensive resource for hospital case managers of all disciplines
By Ellen P. Fink-Samnick
This book is a 'MUST HAVE' for today's professional case manager, especially those practicing in hospitals. A thorough and comprehensive resource on this valuable content is challenging to find. However, this text provides a clear rendering of the fundamentals for hospital based utilization review in the current practice climate. It hits the mark for case managers of all professional backgrounds.
Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
Principal, EFS Supervision Strategies
1 of 1 people found the following review helpful.
Must Reading for everyone who does UR
By Marianne Ramey
Whether you are a novice or seasoned veteran, this book is 'must' reading for all those responsible for performing Utilization Review. It is an easy to read and yet valuable compendium of the latest rules and regulations that are required knowledge for today's UR specialists and has many valuable insights to guide day- to- day practice.
1 of 1 people found the following review helpful.
Great Resource
By Linda Hogel
This would be a great resource for someone new in the field or as a resource for a newly developing department. It should be required reading for all new Utilization Review staff especially management so they understand the magnitude of UR.
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